Continuous Positive Airway Pressure Group Research Articles

Continuous positive airway pressure to reduce the risk of early peripheral oxygen desaturation after onset of apnoea in children: A double-blind randomised controlled trial.

Continuous positive airway pressure (CPAP) during anaesthesia induction improves oxygen saturation (SpO2) outcomes in adults subjected to airway manipulation, and could similarly support oxygenation in children. We evaluated whether CPAP ventilation and passive CPAP oxygenation in children would defer a SpO2 decrease to 95% after apnoea onset compared to the regular technique in which no positive airway pressure is applied. In this double-blind, parallel, randomised controlled clinical trial, 68 children aged 2-6 years with ASA I-II who underwent surgery under general anaesthesia were divided into CPAP and control groups (n = 34 in each group). The intervention was CPAP ventilation and passive CPAP oxygenation using an anaesthesia workstation. The primary outcome was the elapsed time until SpO2 decreased to 95% during a follow-up period of 300 s from apnoea onset (T1). We also recorded the time required to regain baseline levels from an SpO2 of 95% aided by positive pressure ventilation (T2). The median T1 was 278 s (95% confidence interval [CI]: 188-368) in the CPAP group and 124 s (95% CI: 92-157) in the control group (median difference: 154 s; 95% CI: 58-249; p = 0.002). There were 17 (50%) and 32 (94.1%) primary events in the CPAP and control groups, respectively. The hazard ratio was 0.26 (95% CI: 0.14-0.48; p<0.001). The median for T2 was 21 s (95% CI: 13-29) and 29 s (95% CI: 22-36) in the CPAP and control groups, respectively (median difference: 8 s; 95% CI: -3 to 19; p = 0.142). SpO2 was significantly higher in the CPAP group than in the control group throughout the consecutive measures between 60 and 210 s (with p ranging from 0.047 to <0.001). Thus, in the age groups examined, CPAP ventilation and passive CPAP oxygenation deferred SpO2 decrease after apnoea onset compared to the regular technique with no positive airway pressure.

INFLUENCE OF RESPIRATORY SUPPORT STRATEGY DURING CARDIOPULMONARY BYPASS ON LUNGS OXYGENATING FUNCTION

Introduction There are high incidence of pulmonary complications and acute respiratory failure (3,2—28,6%)¹ after cardiac surgery with cardiopulmonary bypass. The study aimed to evaluate the effectiveness of various tactics of respiratory support during cardiopulmonary bypass (CPB) for the prevention of postoperative pulmonary complications. Methods This is a prospective, randomized, controlled clinical study in parallel groups. The study was approved by a local ethics committee. Informed consent was obligatory for all participants. Sixty patients were divided into two groups. In group 1 we provided a continuous positive airway pressure (CPAP) of +5 cm H2O during CPB. In group 2 patients underwent mechanical ventilation with reduced volume (volume control (VC) mode, tidal volume 3 ml / kg of ideal body weight) and respiratory rate of 6 breathes per minute with positive end-expiratory pressure + 5 cm H2O. The primary end-point of the study was the value of the partial pressure of oxygen in arterial blood to oxygen fraction in inhaled gas mixture ratio (paO2/FiO2) at different stages of perioperative management: T1 (after the beginning of mechanical ventilation, T2 (before the CPB), T3 (after CPB), T4 (at the end of the surgery), T5 (upon admission to the ICU), T6 and T7 (6 and 12 hours after surgery, respectively). Secondary end-points were the common lung complications rate (pneumonia, pleural effusion, atelectasis, pneumothorax), the frequency of recruitment maneuvers during the mechanical ventilation, the need for non-invasive ventilation after extubation, the frequency of re-intubation of the trachea. Statistical analysis was carried out in SPSS for Mac v19 (IBM, Inc, USA). Data were presented as mean (±standard deviation) or number (percent). A comparison of the quantitative characteristics was performed using the Mann Whitney U-test. Fisher's exact test was used for the incidence of complications between groups. A p value of less than 0.05 was considered statistically significant. Results The results are presented in Tables 1 and 2. The paO2/FiO2 in the VC group was higher than in the CPAP group at stages T3 and T5. The frequency of recruiting maneuvers in the VC group was lower than in the CPAP group. There was a lower incidence of atelectasis in the VC group than in the CPAP group (Table 2). The low-volume lung ventilation during the CPB is beneficial for oxygenating function of the lungs in comparison with CPAP respiratory support. Discussion The low-volume lung ventilation during the CPB is beneficial for oxygenating function of the lungs in comparison with CPAP respiratory support.

Non-invasive positive airway pressure therapy for improving erectile dysfunction in men with obstructive sleep apnoea.

Non-invasive positive airway pressure therapy for improving erectile dysfunction in men with obstructive sleep apnoea.

Conventional oxygen therapy versus CPAP as a ceiling of care in ward-based patients with COVID-19: a multi-centre cohort evaluation.

BackgroundContinuous positive airway pressure (CPAP) therapy is commonly used for respiratory failure due to severe COVID-19 pneumonitis, including in patients deemed not likely to benefit from invasive mechanical ventilation (nIMV). Little evidence exists demonstrating superiority over conventional oxygen therapy, whilst ward-level delivery of CPAP presents practical challenges. We sought to compare clinical outcomes of oxygen therapy versus CPAP therapy in patients with COVID-19 who were nIMV.MethodsThis retrospective multi-centre cohort evaluation included patients diagnosed with COVID-19 who were nIMV, had a treatment escalation plan of ward-level care and clinical frailty scale ≤ 6. Recruitment occurred during the first two waves of the UK COVID-19 pandemic in 2020; from 1st March to May 31st, and from 1st September to 31st December. Patients given CPAP were compared to patients receiving oxygen therapy that required FiO2 ≥0.4 for more than 12 hours at hospitals not providing ward-level CPAP. Logistic regression modelling was performed to compare 30-day mortality between treatment groups, accounting for important confounders and within-hospital clustering.FindingsSeven hospitals provided data for 479 patients during the UK COVID-19 pandemic in 2020. Overall 30-day mortality was 75.6% in the oxygen group (186/246 patients) and 77.7% in the CPAP group (181/233 patients). A lack of evidence for a treatment effect persisted in the adjusted model (adjusted odds ratio 0.84 95% CI 0.57-1.23, p=0.37). 49.8% of patients receiving CPAP-therapy (118/237) chose to discontinue it.InterpretationNo survival difference was found between using oxygen alone or CPAP to treat patients with severe COVID-19 who were nIMV. A high patient-initiated discontinuation rate for CPAP suggests a significant treatment burden. Further reflection is warranted on the current treatment guidance and widespread application of CPAP in this setting.FundingL Pearmain is supported by the MRC (MR/R00191X/1). TW Felton is supported by the NIHR Manchester Biomedical Research Centre.

Using vital signs measurements to identify patients with COVID-19 who require early continuous positive airway pressure.

The coronavirus disease 2019 (COVID-19) can result in severe pneumonia, leading to acute respiratory distress syndrome, which are treated using continuous positive airway pressure (CPAP). Patients must be evaluated quickly to commence early CPAP if required. To identify patients with COVID-19 in the emergency department (ED) who require early CPAP, using vital signs measurements during triage. This was a retrospective, observational, single-centre cohort study of patients with COVID-19 admitted to the ED of a university hospital in Lombardy, Italy, between 21 February 2020 and 30 April 2020. These patients were divided into two groups: those who required CPAP and those did not require CPAP. Recordings of their vital signs were retrieved from triage medical records. The vital signs values recorded in the two groups on their arrival at the ED were compared. Of 601 patients, 120 (20%) required CPAP. It was identified that the typical characteristics of patients requiring early CPAP were: male (P=.013) with a median age of 68 years (P=.000), oxygen saturation of 92% (P=.000), temperature ≥38°C (P=.008), respiratory rate of 26 breaths per minute (P=.000) and had received pre-hospital oxygen therapy before arriving at the ED (P=.000). The CPAP group was divided into two subgroups: patients who had received pre-hospital oxygen therapy and those who had not. The median respiratory rate values between the two subgroups presented a statistically significant difference (P=.004). This study identified the characteristics of a typical patient with COVID-19 who requires early CPAP. Based on the results, the authors have devised a triage flow chart that uses selected vital signs measurements (oxygen saturation, respiratory rate and receipt of pre-hospital oxygen therapy) to identify patients requiring early CPAP. This flow chart should be trialled in a prospective study before it is used to inform clinical decision-making.

Observational cohort study of changing trends in non-invasive ventilation in very preterm infants and associations with clinical outcomes

ObjectiveTo determine the change in non-invasive ventilation (NIV) use over time in infants born at <32 weeks’ gestation and the associated clinical outcomes.Study designRetrospective cohort study using routinely recorded data...

Comparison of volume-controlled, pressure-controlled, and chest compression-induced ventilation during cardiopulmonary resuscitation with an automated mechanical chest compression device: A randomized clinical pilot study

Aim of the studyAutomated mechanical chest compression devices (AMCCDs) can help performing high-quality cardiopulmonary resuscitation (CPR). Guidelines for CPR are lacking information about the optimal ventilation mode during CPR using AMCCDs. Aim of this pilot study was to compare three common ventilation modes during CPR using AMCCD. MethodsIn this randomized controlled trial, we included patients with an out-of-hospital cardiac arrest arriving at the resuscitation room receiving chest compressions via AMCCD with an expected continuation of at least 15 min. Patients were randomly assigned to three groups: biphasic positive airway pressure with assisted spontaneous ventilation (BIPAP) with assisted spontaneous breathing, continuous positive airway pressure (CPAP) and volume-controlled ventilation (VCV). Outcomes were tidal volume, respiratory minute volume, and end-tidal CO2 during the study period. Groups were compared using generalized linear models. Data is given as median and interquartile ranges. ResultsOf 53 screened patients, 30 were randomized. The tidal volume was significantly (p < 0.05) lower in patients of the CPAP group (68 [64–83] ml) compared with those of the BIPAP (349 [137–500] ml), while the respiratory minute volume differed between the CPAP group (6.2 [5.3–8.1] l/min) and both the BIPAP (7.1 [6.7–10.2] l/min) and VCV group (7.2 [3.7–8.4] l/min). ConclusionsAll ventilation modes achieved an adequate respiratory minute volume during CPR with an AMCCD. However, BIPAP seems to be superior due to the higher tidal volume. Therefore, we recommend starting mechanical ventilation when using AMCCD with BIPAP ventilation to avoid risks related to dead space ventilation.

Non-invasive duo positive airway pressure ventilation versus nasal continuous positive airway pressure in preterm infants with respiratory distress syndrome: a randomized controlled trial

BackgroundThe most common cause of respiratory failure in premature infants is respiratory distress syndrome. Historically, respiratory distress syndrome has been treated by intratracheal surfactant injection followed by mechanical ventilation. In view of the risk of pulmonary injury associated with mechanical ventilation and subsequent chronic pulmonary lung disease, less invasive treatment modalities have been suggested to reduce pulmonary complications.Methods148 neonates (with gestational age of 28 to 34 weeks) with respiratory distress syndrome admitted to Imam Khomeini Hospital in Ahwaz in 2018 were enrolled in this clinical trial study. 74 neonates were assigned to duo positive airway pressure (NDUOPAP) group and 74 neonates to nasal continuous positive airway pressure (NCPAP) group. The primary outcome in this study was failure of N-DUOPAP and NCPAP treatments within the first 72 h after birth and secondary outcomes included treatment complications.Resultsthere was not significant difference between DUOPAP (4.1 %) and NCPAP (8.1 %) in treatment failure at the first 72 h of birth (p = 0.494), but non-invasive ventilation time was less in the DUOPAP group (p = 0.004). There were not significant differences in the frequency of patent ductus arteriosus (PDA), pneumothorax, intraventricular hemorrhage (IVH) and bronchopulmonary dysplasia (BPD), apnea and mortality between the two groups. Need for repeated doses of surfactant (p = 0.042) in the NDUOPAP group was significantly lower than that of the NCPAP group. The duration of oxygen therapy in the NDUOPAP group was significantly lower than that of the NCPAP group (p = 0.034). Also, the duration of hospitalization in the NDUOPAP group was shorter than that of the NCPAP group (p = 0.002).ConclusionsIn the present study, DUOPAP compared to NCPAP did not reduce the need for mechanical ventilation during the first 72 h of birth, but the duration of non-invasive ventilation and oxygen demand, the need for multiple doses of surfactant and length of stay in the DUOPAP group were less than those in the CPAP group.Trial registrationIRCT20180821040847N1, Approved on 2018-09-10.

Postoperative continuous positive airway pressure to prevent pneumonia, re-intubation, and death after major abdominal surgery (PRISM): a multicentre, open-label, randomised, phase 3 trial

Respiratory complications are an important cause of postoperative morbidity. We aimed to investigate whether continuous positive airway pressure (CPAP) administered immediately after major abdominal surgery could prevent postoperative morbidity. PRISM was an open-label, randomised, phase 3 trial done at 70 hospitals across six countries. Patients aged 50 years or older who were undergoing elective major open abdominal surgery were randomly assigned (1:1) to receive CPAP within 4 h of the end of surgery or usual postoperative care. Patients were randomly assigned using a computer-generated minimisation algorithm with inbuilt concealment. The primary outcome was a composite of pneumonia, endotracheal re-intubation, or death within 30 days after randomisation, assessed in the intention-to-treat population. Safety was assessed in all patients who received CPAP. The trial is registered with the ISRCTN registry, ISRCTN56012545. Between Feb 8, 2016, and Nov 11, 2019, 4806 patients were randomly assigned (2405 to the CPAP group and 2401 to the usual care group), of whom 4793 were included in the primary analysis (2396 in the CPAP group and 2397 in the usual care group). 195 (8·1%) of 2396 patients in the CPAP group and 197 (8·2%) of 2397 patients in the usual care group met the composite primary outcome (adjusted odds ratio 1·01 [95% CI 0·81-1·24]; p=0·95). 200 (8·9%) of 2241 patients in the CPAP group had adverse events. The most common adverse events were claustrophobia (78 [3·5%] of 2241 patients), oronasal dryness (43 [1·9%]), excessive air leak (36 [1·6%]), vomiting (26 [1·2%]), and pain (24 [1·1%]). There were two serious adverse events: one patient had significant hearing loss and one patient had obstruction of their venous catheter caused by a CPAP hood, which resulted in transient haemodynamic instability. In this large clinical effectiveness trial, CPAP did not reduce the incidence of pneumonia, endotracheal re-intubation, or death after major abdominal surgery. Although CPAP has an important role in the treatment of respiratory failure after surgery, routine use of prophylactic post-operative CPAP is not recommended. National Institute for Health Research, Barts Charity, Intersurgical, Association of Anaesthetists, and Sapienza Università di Roma.

Paediatric CPAP in the digital age

ObjectivesAdherence to Continuous Positive Airway Pressure (CPAP) in children can be challenging. Advancements in CPAP technology have potential to influence adherence. The aim of this study was to compare adherence rates of children with obstructive sleep apnoea (OSA) initiated on autotitrating CPAP (APAP) with remote modem monitoring compared to a cohort started on fixed pressure CPAP alone. MethodsChildren aged over 3 years starting APAP at our centre between February 2017 and February 2020 were included. Therapy data was obtained for the initial 90 days. Data was compared to a cohort of children started on CPAP between July 2004 and September 2008. ResultsA total of 61 patients with a median age of 14.3 years formed the APAP group, and were significantly older than the CPAP group who had a median age of 8.6 years (p = 0.02). Co-morbid conditions were present in 51% compared with 69% in the earlier cohort (p = 0.11). No significant difference was found in any adherence parameters between the groups. The value closest to achieving a significant difference was hours used per day used, with an median of 5.2 h in the CPAP group compared with 7.0 h in the APAP group (p = 0.07). Two-way ANOVA including age group (above or below 13 years) showed that both age group and treatment group (CPAP vs APAP) were significantly associated with a difference in adherence (F = 4.41, p = 0.006), with mean hours used on days used being highest in the APAP group aged under 13 years. However no significant interaction was found between age and treatment group. ConclusionDespite the convenience for patients with outpatient initiation and ability to achieve optimal pressures quickly and remotely, our results show no improvement in adherence using APAP with remote monitoring, with the possible exception of children aged under 13 years. A large randomized controlled trial would be required to confirm these findings.

Bi-level Nasal Positive Airway Pressure (BiPAP) versus Nasal Continuous Positive Airway Pressure (CPAP) for Preterm Infants with Birth Weight Less Than 1500 g and Respiratory Distress Syndrome Following INSURE Treatment: A Two-center Randomized Controlled Trial.

The present study aimed to examine the effectiveness of bi-level positive airway pressure (BiPAP) versus continuous positive airway pressure (CPAP) in preterm infants with birth weight less than 1500 g and respiratory distress syndrome (RDS) following intubation-surfactant-extubation (INSURE) treatment. A two-center randomized control trial was performed. The primary outcome was the reintubation rate of infants within 72 h of age after INSURE. Secondary outcomes included bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP) and incidences of adverse events. Lung function at one year of corrected age was also compared between the two groups. There were 140 cases in the CPAP group and 144 in the BiPAP group. After INSURE, the reintubation rates of infants within 72 h of age were 15% and 11.1% in the CPAP group and the BiPAP group, respectively (P>0.05). Neonates in the BiPAP group was on positive airway pressure (PAP) therapy three days less than in the CPAP group (12.6 d and 15.3 d, respectively, P<0.05), and on oxygen six days less than in the CPAP group (20.6 d and 26.9 d, respectively, P<0.05). Other outcomes such as BPD, NEC, ROP and feeding intolerance were not significantly different between the two groups (P>0.05). There was no difference in lung function at one year of age between the two groups (P>0.05). In conclusion, after INSURE, the reintubation rate of infants within 72 h of age was comparable between the BiPAP group and the CPAP group. BiPAP was superior to CPAP in terms of shorter durations (days) on PAP support and oxygen supplementation. There were no differences in the incidences of BPD and ROP, and lung function at one year of age between the two ventilation methods.

Continuous positive airway pressure adherence and blood pressure lowering in patients with obstructive sleep apnoea syndrome and nocturnal hypertension

Purpose We investigated continuous positive airway pressure (CPAP) adherence and its association with the blood pressure (BP) and pulse rate changes in patients with obstructive sleep apnoea syndrome (OSAS) and hypertension. Materials and methods In a single-blind trial, patients were randomly assigned to CPAP or sham CPAP treatment for 3 months. We performed clinic, ambulatory and home BP measurements at baseline and during follow-up. CPAP adherence was assessed as the CPAP frequency per week and time per night. Non-adherence was defined as a CPAP use for <5 days/week or <4 h/night. Results In the CPAP (n = 26) and sham CPAP groups (n = 21), the CPAP frequency was 5.5 and 4.8 days/week (p = 0.17), respectively, and the CPAP time was 5.0 and 4.1 h/night (p = 0.03), respectively. The corresponding prevalence of non-adherence was 46.2% and 66.7% (p = 0.16), respectively. The CPAP frequency but not time tended to be associated with the changes in BP and pulse rate at 3 months of follow-up, especially home systolic/diastolic BP in the CPAP group (3.2/1.3 mmHg greater reductions per 1 day increment, p ≤ 0.01). Adherent, compared with non-adherent patients, had greater reductions in BP or pulse rate at 3 months of follow-up. In the CPAP and sham CPAP groups combined, statistical significance was achieved for the adjusted between adherence and non-adherence differences in home systolic/diastolic BP (–5.0/–3.8 mmHg) and 24-h, daytime and night-time ambulatory pulse rate (–6.2, −7.8 and −4.4 beats/min, respectively, p ≤ 0.04). Conclusion CPAP adherence was associated with the BP lowering and pulse rate slowing effects, especially the CPAP frequency.

Effect of Continuous Positive Airway Pressure on Arrhythmia in Atrial Fibrillation and Sleep Apnea: A Randomized Controlled Trial.

Rationale: Sleep apnea (SA) is highly prevalent in patients with atrial fibrillation (AF), and both conditions are associated with adverse cardiovascular outcomes.Objectives: To determine the effect of continuous positive airway pressure (CPAP) on AF burden.Methods: This open-label, parallel-group, randomized controlled trial included patients with paroxysmal AF and moderate to severe SA (apnea-hypopnea index ⩾15). A computerized system randomized eligible patients (1:1) to 5 months' treatment with CPAP plus usual care (CPAP, n = 55) or usual care alone (control, n = 54). The outcome assessment was blinded. The planned primary outcome was the difference between CPAP treatment and control groups in change of AF burden (percentage of time in AF) as measured by implantable loop recorder.Measurements and Main Results: A total of 579 patients with paroxysmal AF had respiratory polygraphy, of whom 244 (42%) had moderate to severe SA. Of these, 158 (65%) participated in the CPAP run-in period, of whom 39 (25%) patients did not tolerate the treatment. A total of 108 patients were available for the primary analysis. The mean time in AF decreased from 5.6% at baseline to 4.1% during the last 3 months of CPAP intervention and from 5.0% to 4.3% in the control group. The adjusted between-group difference at follow-up was -0.63 (95% confidence interval, -2.55 to 1.30) percentage points (P = 0.52). Seven serious adverse events (13%) occurred in the CPAP group, and two (4%) occurred in the control group.Conclusions: In patients with paroxysmal AF and SA, treatment with CPAP did not result in a statistically significant reduction in the burden of AF.Clinical trial registered with www.clinicaltrials.gov (NCT02727192).

Effects of continuous positive airway pressure treatment in obstructive sleep apnea patients with atrial fibrillation: A meta-analysis.

Background:Obstructive sleep apnea (OSA) is correlated with atrial fibrillation (AF). Over the past decade, there has been an increasing interest in the relationship between OSA with continuous positive airway pressure (CPAP) and progression or recurrence of AF.Methods:This investigation was an analysis of studies searched in the Cochrane Library, PubMed, EMBASE, EBSCO, OVID, and Web of Science databases from inception to July 2020 to evaluate the recurrence or progression of AF in CPAP users, CPAP nonusers, and patients without OSA.Results:Nine studies with 14,812 patients were recruited. CPAP therapy reduced the risk of AF recurrence or progression by 63% in a random-effects model (24.8% vs 40.5%, risk ratio [RR] = 0.70, 95% confidence interval [CI] = 0.57–0.85, P = .035). Compared with non-OSA patients, AF recurrence or progression was much higher in CPAP nonusers (40.6% vs 21.1%, RR = 1.70, 95% CI = 1.19–2.43, P = .000). However, AF recurrence or progression in the CPAP group was similar to that in the non-OSA group (24.0% vs 21.1%, RR = 1.13, 95% CI = 0.87–1.47, P = .001). Begg correlation test and Egger regression test revealed no publication bias in this analysis.Conclusions:OSA is a salient factor in the progression or recurrence of AF. CPAP therapy for OSA may contribute to reduction of AF in patients for whom radiofrequency ablation or direct current cardioversion is not performed.Trial Registration:The protocol for this meta-analysis was registered on PROSPERO with a registration No. CRD42019135229.

Comparative study between noninvasive ventilation with continuous positive airway pressure mask versus stacked breathing on chest expansion and pulmonary function in patients with pneumonia

Background: Majority of patients with pneumonia fail the treatment by the noninvasive ventilation (NIV), not because of its low efficacy for maintaining upper airway patency but because of intolerance. The current study was designed to compare the effectiveness of stacked breathing exercise (SBE) versus continuous positive airway pressure (CPAP) mask on the chest expansion and pulmonary functions for patients with pneumonia.&#x0D; Methodology: A randomized controlled experimental study was conducted in chest ICU in Assiut University Hospital in Egypt and registered at www.clinicaltrials.gov (NCT04576221 identifier). Sixty patients with pneumonia were selected by convenience sampling and randomly assigned into two groups (30 patients each), the patients in SB group received SBE and were instructed to perform the exercise 3 times per day for one week; and the CPAP group received NIV with using CPAP mask. Chest expansion and pulmonary functions were assessed before and after the exercise.&#x0D; Results: There were significant differences in chest expansion and pulmonary functions between the SB and CPAP groups after exercise in the first day, after 3 days and on the last day of the study (p=0.018, &lt; 0.001 and &lt; 0.001) respectively. Chest expansion and pulmonary functions in the SB group was much improved than those in the CPAP group.&#x0D; Conclusions: Implementing SB exercise had a significant effect on improving chest expansion and pulmonary functions in patients with pneumonia than NIV with CPAP mask.&#x0D; Key words: Chest expansion; CPAP mask; Pneumonia; Pulmonary Function; Stacked breathing&#x0D; Citation: Ahmed AT, Abou Galalah AA, Mahgoub AA, Mahran GS. Comparative study between noninvasive ventilation with continuous positive airway pressure mask versus stacked breathing on chest expansion and pulmonary function in patients with pneumonia. Anaesth. pain intensive care 2021;25(2):176-184. DOI: 10.35975/apic.v25i2.1470&#x0D; Received: 2 November 2020, Reviewed: 2 December 2020, Accepted: 24 March 2021

Examining the Relationship Between CPAP Adherence and Attention/executive functioning Among OSA-Diagnosed Older Adults

<h3>Introduction</h3> BACKGROUND: Obstructive sleep apnea (OSA) is a treatable respiratory condition that becomes more prevalent with age. The extant literature suggests OSA is associated with domain-general cognitive dysfunction, though attention/executive skills may be disproportionately affected (Stranks & Crowe, 2016). Meta-analytic data further suggest that treatment with continuous positive airway pressure (CPAP) can result in small to medium improvements in executive function (Olaithe & Bucks, 2013). However, the relationship between CPAP adherence and executive dysfunction <i>in older adults</i> is less clear – an important target of investigation given mounting evidence demonstrating a link between OSA and age-related cognitive decline, including Alzheimer's disease (Mullins et al., 2020). Accordingly, the current study examined the relationship between self-reported CPAP adherence and attention/executive function, namely basic attention span and executive control, in a mixed clinical sample of older adults with OSA. <h3>Methods</h3> METHODS: Data were obtained from the McLean Hospital Neuropsychology Data Repository, which is a comprehensive, archival dataset comprised of patients who completed a neuropsychological evaluation as part of routine clinical care. The current study examined a transdiagnostic subset of older adults aged 50+ years with OSA. Data were analyzed using univariate general linear models, with self-reported CPAP adherence (i.e., no CPAP vs full/partial adherence) as a fixed factor, performance on each condition of the WAIS-IV Digit Span task as outcome variables, and age as a covariate. <h3>Results</h3> RESULTS: Of the sample used (N=52), 52% were either fully or partially CPAP compliant (n=27), whereas 48% were entirely non-compliant (n=25). Significant performance differences (p<.05) were observed on the digit span backwards task (p=.025), with the full/partial CPAP adherence group (M=53.07, SD=10.183) performing better than the no CPAP (M=47.44, SD=6.764) group. <h3>Conclusions</h3> DISCUSSION: These results suggest that at least some degree of CPAP treatment adherence amongst OSA-diagnosed older adults may improve working memory cognitive processes, compared to non-compliancy. <h3>Limitations</h3> Further research should consider methods for accurately quantifying OSA severity and CPAP treatment (i.e., partial versus full compliancy), distinguishing OSA diagnosis/treatment between different age demographics (i.e., middle adults versus older adults), determining possible relationships between time of diagnosis and initiating treatment/non-treatment, and controlling for co-occurring variables that impact sleep and cognitive functioning (i.e., medication side effects, comorbid vascular and respiratory conditions, psychiatric comorbidities). Future studies should also consider examining larger, age-specific OSA populations, with a more extensive examination of neurocognitive functioning across domains that have been suggested to be strongly influenced by working memory processes (e.g., attention, learning/memory, executive functioning). <h3>Funding</h3> N/A

Synchronized Nasal Intermittent Positive Pressure Ventilation versus Nasal Continuous Positive Airway Pressure for Prevention of Extubation Failure in Infants after Congenital Heart Surgery.

This study aimed to evaluate the application of synchronized nasal intermittent positive pressure ventilation (SNIPPV) in the respiratory weaning of infants after congenital heart surgery. We retrospectively analyzed the clinical data of 63 infants who were extubated from mechanical ventilation after congenital heart surgery between January 2020 and September 2020. The data, including demographics, anatomic diagnosis, radiology and laboratory test results, and perioperative variables were recorded. The extubation failure rate within 48 h after extubation was significantly lower in the SNIPPV group than in the nasal continuous positive airway pressure (NCPAP) group. The PaO2 level and PaO2/FiO2 ratio within 48 h after extubation were higher in the SNIPPV group than in the NCPAP group (P < .05). Meanwhile, the PaCO2 level within 48 h was significantly lower in the SNIPPV group (P < .05). Compared with the NCPAP group, the median duration of postoperative noninvasive support and the duration from extubation to hospital discharge were shorter in the SNIPPV group; the total hospital cost was lower in the SNIPPV group. No significant differences were observed between the two groups concerning VAP, pneumothorax, feeding intolerance, sepsis, mortality, and other complications (P > .05). SNIPPV was shown to be superior to NCPAP in avoiding reintubation after congenital heart surgery in infants and significantly improved oxygenation and reduced PaCO2 retention after extubation. Further studies are needed to confirm the efficacy and safety of SNIPPV as a routine weaning strategy.

Comparison of CPAP and oxygen therapy for treatment of postoperative hypoxaemia in dogs.

To compare 5cmH2 O of continuous positive airway pressure with oxygen therapy in dogs recovering from general anaesthesia with low SpO2 values. continuous positive airway pressure is more effective than oxygen therapy in restoring normoxaemia (SpO2 ≥95%). Prospectively, dogs recovering from anaesthesia, with SpO2 <95% after extubation (T0), were randomised and treated with continuous positive airway pressure (FiO2 0.21) or oxygen (O2 ; FiO2 0.35-0.40) therapy. Dogs were monitored with SpO2 every 15 minutes for 1hour (T15, T30, T45, T60). Data from normoxaemic dogs (SpO2 >95%) were used as control (CTR). Of the 42 dogs enrolled, 34 completed the study. Eleven dogs were treated with O2 , 10 with continuous positive airway pressure and 13 were CTR. The SpO2 values at T0 were similar in the continuous positive airway pressure and O2 groups and were lower than in the CTR group. At T15, T30, T45 and T60, the SpO2 values in the continuous positive airway pressure group were higher than at T0; these were similar to those of the CTR group at the same time-points. In the O2 group, SpO2 values were significantly higher at T45 and T60 than at T0; 45.5% of dogs became normoxaemic at T45 and the remaining dogs became normoxaemic at T60. The average time to reach normoxaemia in the O2 group (53.1±7.3 minutes) was longer than in the continuous positive airway pressure group (15.0±0.0 minutes). In dogs recovering from general anaesthesia with pulmonary gas exchange impairment, normoxaemia is restored more effectively and rapidly by using continuous positive airway pressure than by oxygen therapy.

Impact of continuous positive airway pressure mode on adherence to treatment in obstructive sleep apnea patients awaiting bariatric surgery.

Obstructive sleep apnea is prevalent in the bariatric population, and is associated with various complications. Despite increasing popularity, automatic positive airway pressure has not yet been studied in this population. The objective was to compare treatment adherence between automatic positive airway pressure and fixed positive airway pressure (continuous positive airway pressure) in obstructive sleep apnea patients awaiting bariatric surgery. This randomized controlled trial involved obese patients newly diagnosed with severe obstructive sleep apnea and awaiting bariatric surgery. The primary outcome was the difference in adherence between automatic positive airway pressure and continuous positive airway pressure pre-operatively. Secondary outcomes included positive airway pressure efficacy, adherence at 1 month, adverse effects, quality of life and peri-operative complications. Analyses were conducted using a modified intention-to-treat methodology. Fifty patients were randomized. Baseline characteristics and duration of positive airway pressure therapy were comparable between groups. At the time of surgery, the percentage of overall nights positive airway pressure used was 96.9% [95% confidence interval: 93.5-100] and 86.0% [95% confidence interval: 66.9-100] in the automatic positive airway pressure and continuous positive airway pressure groups, respectively (p=.047). Average use was 6.3hr per night [95% confidence interval: 5.1-7.2] and 5.9hr per night [95% confidence interval: 3.0-8.8], with a difference of 0.4hr favouring automatic positive airway pressure (p=.75). Nightly use≥4 hr per night was 86.4% and 74.0% in the automatic positive airway pressure and fixed continuous positive airway pressure groups, respectively (p=.22). There were no statistically significant differences regarding adherence at 1 month, efficacy parameters, adverse effects, quality of life and peri-operative complications. With no difference on the safety profile and efficiency parameters, treatment adherence is not improved with automatic positive airway pressure compared with fixed continuous positive airway pressure in obstructive sleep apnea patients awaiting bariatric surgery.

Non-invasive high-frequency oscillatory ventilation in preterm infants after extubation: a randomized, controlled trial.

ObjectiveTo investigate the effectiveness and safety of non-invasive high-frequency oscillatory ventilation (NHFOV) in post-extubation preterm infants.MethodsThis was a randomized, controlled trial. A total of 149 preterm infants aged between 25 to 34 weeks’ gestational age with a birth weight of <1500 g who required invasive mechanical ventilation on admission were included. After extubation, they were randomized to the NHFOV group (n = 47), nasal intermittent positive pressure ventilation (NIPPV) group (n = 51), or nasal continuous positive airway pressure (NCPAP) group (n = 51). We compared the effectiveness and safety among these three groups.ResultsA total of 139 preterm infants finally completed the study. The reintubation rate was significantly lower in the NHFOV group than in the other groups. The duration of non-invasive ventilation and the length of hospital stay in the NHFOV and NIPPV groups were significantly shorter than those in the NCPAP group. The incidence of bronchopulmonary dysplasia in the NHFOV and NIPPV groups was significantly lower than that in the NCPAP group. The NHFOV group had significantly less nasal injury than the NCPAP group.ConclusionAs post-extubation respiratory support in preterm infants, NHFOV has a lower reintubation rate compared with NCPAP and NIPPV, without increasing the rate of complications.